Efficacy of postoperative elective ventilatory support for leakage protection in primary anastomosis of congenital esophageal atresia

Uchida, Keiichi; Inoue, Mikihiro; Otake, Kohei; Okita, Yoshiki; Morimoto, Yuki; Araki, Toshimitsu; Miki, Chikao; Kusunoki, Masato

doi:10.1007/s00383-006-1700-1

Cited by 24 publications

(6 citation statements)

References 17 publications

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“…[13][14][15][16] More than half of the respondents electively paralyze their patients, mainly to reduce anastomotic complications by decreasing anastomotic tension. This approach, initially described by Spitz et al in 1987, 17 later reported by some groups, 18,19 should decrease the risk of anastomotic complications.…”

Section: Discussionmentioning

confidence: 98%

International Survey on the Management of Esophageal Atresia

et al. 2013

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Introduction Because many aspects of the management of esophageal atresia (EA) are still controversial, we evaluated the practice patterns of this condition across Europe. Methods A survey was completed by 178 delegates (from 45 [27 European] countries; 88% senior respondents) at the EUPSA-BAPS 2012. Results Approximately 66% of respondents work in centers where more than five EA repairs are performed per year. Preoperatively, 81% of respondents request an echocardiogram, and only 43% of respondents routinely perform preoperative bronchoscopy. Approximately 94% of respondents prefer an open approach, which is extrapleural in 71% of respondents. There were no differences in use of thoracoscopy between Europeans (10%) and non-Europeans (11%, p ¼ nonsignificant). Approximately 60% of respondents measure the gap intraoperatively. A transanastomotic tube (90%)

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Section: Discussionmentioning

confidence: 98%

International Survey on the Management of Esophageal Atresia

et al. 2013

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“…The authors isolated mainly highly resistant Gram-negative bacteria (i.e., Escherichia coli , Klebsiella pneumoniae , Acinetobacter baumannii , Pseudomonas aeruginosa , Enterobacter cloacae ) from the pleural drainage fluid of 12/21 newborns. To prevent anastomotic leaks, some authors have suggested the early use of broad-spectrum antibiotics and continuous suctioning of the upper pouch, parenteral nutrition, or trans-anastomotic tube feeding and postoperative elective ventilatory support [ 22 , 23 ].…”

Section: Early Respiratory Morbiditymentioning

confidence: 99%

Respiratory Morbidity in Children with Repaired Congenital Esophageal Atresia with or without Tracheoesophageal Fistula

Patria

Ghislanzoni

Macchini

et al. 2017

IJERPH

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Congenital esophageal atresia with or without tracheoesophageal fistula (CEA ± TEF) is a relatively common malformation that occurs in 1 of 2500–4500 live births. Despite the refinement of surgical techniques, a considerable proportion of children experience short- and long-term respiratory complications, which can significantly affect their health through adulthood. This review focuses on the underlying mechanisms and clinical presentation of respiratory morbidity in children with repaired CEA ± TEF. The reasons for the short-term pulmonary impairments are multifactorial and related to the surgical complications, such as anastomotic leaks, stenosis, and recurrence of fistula. Long-term respiratory morbidity is grouped into four categories according to the body section or function mainly involved: upper respiratory tract, lower respiratory tract, gastrointestinal tract, and aspiration and dysphagia. The reasons for the persistence of respiratory morbidity to adulthood are not univocal. The malformation itself, the acquired damage after the surgical repair, various co-morbidities, and the recurrence of lower respiratory tract infections at an early age can contribute to pulmonary impairment. Nevertheless, other conditions, including smoking habits and, in particular, atopy can play a role in the recurrence of infections. In conclusion, our manuscript shows that most children born with CEA ± TEF survive into adulthood, but many comorbidities, mainly esophageal and respiratory issues, may persist. The pulmonary impairment involves many underlying mechanisms, which begin in the first years of life. Therefore, early detection and management of pulmonary morbidity may be important to prevent impairment in pulmonary function and serious long-term complications. To obtain a successful outcome, it is fundamental to ensure a standardized follow-up that must continue until adulthood.

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“…Post‐operative management of tracheoesophageal fistula (TEF)/oesophageal atresia (EA) includes provision of mechanical ventilation (MV) . Because prolonged MV carries the risk of pneumonia, atelectasis and other morbidities, early extubation is preferable; but post‐extubation atelectasis or tracheomalacia might warrant re‐intubation.…”

Section: What This Paper Addsmentioning

confidence: 99%